Contribution of symmetric dimethylarginine to GFR decline in pediatric chronic kidney disease

Ellen R Brooks*, Shannon Haymond, Alfred W Rademaker, Christopher Pierce, Irene Helenowski, Rod S Passman, Faye Vicente, Bradley A. Warady, Susan L. Furth, Craig Langman

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: In pediatric chronic kidney disease (pCKD), traditional factors (proteinuria, etiology, and race) do not fully explain disease progression. The levels of methylated arginine derivatives (MADs: asymmetric and symmetric dimethylarginine, respectively) rise in CKD and increase with CKD progression. The impact of MADs on glomerular filtration rate (GFR) decline has not been examined in pCKD. The aim of this study was to examine the additive impact of baseline (BL) levels of MADs on directly measured GFR (mGFR) decline per year (ml/min/1.73 m2/year) for a period of up to 4 years. Methods: Plasma and data, including mGFR by plasma iohexol clearance, were provided by the prospective, observational Chronic Kidney Disease in Children study. BL MADs were analyzed by high-performance liquid chromatography–tandem mass spectrometry. Results: For 352 pCKD subjects, the median [interquartile range] BL mGFR was 45 [35, 57] ml/min/1.73 m2. The levels of BL MADs were inversely related to the initial mGFR and its decline over time (p < 0.0005) but not to the rate of decline. Covariates, non-glomerulopathy and Tanner stage of ≥ 3 demonstrated weaker relationships between BL levels and beginning mGFR (p = 0.004 and p = 0.002, respectively). Conclusions: In pCKD, higher concentrations of BL MADs were inversely related to BL mGFR. MADs did not affect the CKD progression rate. Quantification of this relationship is novel to the pCKD literature.

Original languageEnglish (US)
Pages (from-to)697-704
Number of pages8
JournalPediatric Nephrology
Volume33
Issue number4
DOIs
StatePublished - Apr 1 2018

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Glomerular Filtration Rate
Chronic Renal Insufficiency
Pediatrics
Iohexol
mycophenolic adenine dinucleotide
N,N'-dimethylarginine
Proteinuria
Arginine
Disease Progression
Mass Spectrometry

Keywords

  • CKD progression
  • Chronic kidney disease
  • Methylated arginine derivatives
  • Pediatric
  • SDMA

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nephrology

Cite this

Brooks, Ellen R ; Haymond, Shannon ; Rademaker, Alfred W ; Pierce, Christopher ; Helenowski, Irene ; Passman, Rod S ; Vicente, Faye ; Warady, Bradley A. ; Furth, Susan L. ; Langman, Craig. / Contribution of symmetric dimethylarginine to GFR decline in pediatric chronic kidney disease. In: Pediatric Nephrology. 2018 ; Vol. 33, No. 4. pp. 697-704.
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Contribution of symmetric dimethylarginine to GFR decline in pediatric chronic kidney disease. / Brooks, Ellen R; Haymond, Shannon; Rademaker, Alfred W; Pierce, Christopher; Helenowski, Irene; Passman, Rod S; Vicente, Faye; Warady, Bradley A.; Furth, Susan L.; Langman, Craig.

In: Pediatric Nephrology, Vol. 33, No. 4, 01.04.2018, p. 697-704.

Research output: Contribution to journalArticle

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T1 - Contribution of symmetric dimethylarginine to GFR decline in pediatric chronic kidney disease

AU - Brooks, Ellen R

AU - Haymond, Shannon

AU - Rademaker, Alfred W

AU - Pierce, Christopher

AU - Helenowski, Irene

AU - Passman, Rod S

AU - Vicente, Faye

AU - Warady, Bradley A.

AU - Furth, Susan L.

AU - Langman, Craig

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Background: In pediatric chronic kidney disease (pCKD), traditional factors (proteinuria, etiology, and race) do not fully explain disease progression. The levels of methylated arginine derivatives (MADs: asymmetric and symmetric dimethylarginine, respectively) rise in CKD and increase with CKD progression. The impact of MADs on glomerular filtration rate (GFR) decline has not been examined in pCKD. The aim of this study was to examine the additive impact of baseline (BL) levels of MADs on directly measured GFR (mGFR) decline per year (ml/min/1.73 m2/year) for a period of up to 4 years. Methods: Plasma and data, including mGFR by plasma iohexol clearance, were provided by the prospective, observational Chronic Kidney Disease in Children study. BL MADs were analyzed by high-performance liquid chromatography–tandem mass spectrometry. Results: For 352 pCKD subjects, the median [interquartile range] BL mGFR was 45 [35, 57] ml/min/1.73 m2. The levels of BL MADs were inversely related to the initial mGFR and its decline over time (p < 0.0005) but not to the rate of decline. Covariates, non-glomerulopathy and Tanner stage of ≥ 3 demonstrated weaker relationships between BL levels and beginning mGFR (p = 0.004 and p = 0.002, respectively). Conclusions: In pCKD, higher concentrations of BL MADs were inversely related to BL mGFR. MADs did not affect the CKD progression rate. Quantification of this relationship is novel to the pCKD literature.

AB - Background: In pediatric chronic kidney disease (pCKD), traditional factors (proteinuria, etiology, and race) do not fully explain disease progression. The levels of methylated arginine derivatives (MADs: asymmetric and symmetric dimethylarginine, respectively) rise in CKD and increase with CKD progression. The impact of MADs on glomerular filtration rate (GFR) decline has not been examined in pCKD. The aim of this study was to examine the additive impact of baseline (BL) levels of MADs on directly measured GFR (mGFR) decline per year (ml/min/1.73 m2/year) for a period of up to 4 years. Methods: Plasma and data, including mGFR by plasma iohexol clearance, were provided by the prospective, observational Chronic Kidney Disease in Children study. BL MADs were analyzed by high-performance liquid chromatography–tandem mass spectrometry. Results: For 352 pCKD subjects, the median [interquartile range] BL mGFR was 45 [35, 57] ml/min/1.73 m2. The levels of BL MADs were inversely related to the initial mGFR and its decline over time (p < 0.0005) but not to the rate of decline. Covariates, non-glomerulopathy and Tanner stage of ≥ 3 demonstrated weaker relationships between BL levels and beginning mGFR (p = 0.004 and p = 0.002, respectively). Conclusions: In pCKD, higher concentrations of BL MADs were inversely related to BL mGFR. MADs did not affect the CKD progression rate. Quantification of this relationship is novel to the pCKD literature.

KW - CKD progression

KW - Chronic kidney disease

KW - Methylated arginine derivatives

KW - Pediatric

KW - SDMA

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